Neil R. Powe, MD, is Professor of Medicine and Director of the Welch Center at the Johns Hopkins University School of Medicine. He holds a joint appointment in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health where he is the Director of the Clinical Epidemiology Program. He is seeking renewal of this Mid-career Award in Patient-oriented Research to enhance his efforts in clinical research in kidney disease and to continue to build the training program in kidney disease research. Dr. Powe has conducted several clinical investigations in nephrology including studies of: etiology (racial disparities in occurrence of ESRD and a randomized clinical trial of low-versus highosmolality contrast media-induced nephrotoxicity); diagnosis (comparison of physical examination with color flow doppler for detection of vascular access failure); therapy (effectiveness of recombinant human erythropoietin for treatment of anemia of ESRD); and prognosis (incidence, risk factors and prognosis of septicemia and comorbid cardiovascular disease in ESRD patients); and determinants of health disparities. Dr. Powe directs the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) study. This is a national prospective cohort study comparing treatment and outcomes in hemodialysis and peritoneal dialysis patients. The study has 1041 patients enrolled, making it one of the largest and most representative prospective cohorts of dialysis patients ever studied in the U.S. Data on medical history, laboratory studies, comorbidity and severity of disease and clinical outcomes are being collected. The study has also established a specimen bank which provides opportunities for examining mechanisms for the consequences of kidney disease or its treatment. Ethnic minorities make up a disproportionate share of the population with ESRD. Dr. Powe would like to extend his work into understanding the biologic, clinical and behavioral determinants of racial and ethnic disparities in chronic kidney disease. Dr. Powe has mentored a cadre of trainees and junior faculty in clinical research in kidney disease. Renewal of this award will permit Dr. Powe to make an even greater contribution to patient-oriented research in nephrology, amplifying his efforts and helping him produce future clinical scientists who are rigorously prepared to become independent investigators in kidney disease research.